Organization Name: | STUART FAMILY MEDICINE, PLLC |
NPI Number: | 1255633822 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | DANNA K STUART (SOLE MEMBER) |
Mailing Address: | 404 South Main St Shattuck |
State: | OK US |
Postal Code: | 73858 |
Phone Number: | 5809385400 |
Fax Number: | 5809385409 |
NPI Enumeration Date: | 12/02/2010 |
NPI Last Update Date: | 12/02/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QP2300X |
License Number: | 24874 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OK |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Primary Care |
Taxonomy Definition: |